Healthcare Provider Details

I. General information

NPI: 1598353526
Provider Name (Legal Business Name): MICHIGAN COMPASSIONATE CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28401 HOOVER RD
WARREN MI
48093-5438
US

IV. Provider business mailing address

28401 HOOVER RD
WARREN MI
48093-5438
US

V. Phone/Fax

Practice location:
  • Phone: 586-754-3830
  • Fax: 586-754-3840
Mailing address:
  • Phone: 586-754-3830
  • Fax: 586-754-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD VASIQ
Title or Position: CEO
Credential: MD
Phone: 205-215-9892